Health plans have a lot at stake in this value-based market. Purchasers, including large employer groups, and government programs, such as Medicare and Medicaid, are demanding higher quality and more value. Quality improvement and HEDIS results are at the forefront of value-based payment structures, with millions of dollars in incentive payments on the line every year. And risk adjustment is the key to maximizing premium revenue for chronically ill patients. Health plans have been focused on population management for many years, but now it is more important than ever.
Health plans can only be successful in this new world by partnering with providers in a deeper and more meaningful way. Simply pushing new contract requirements down to providers and expecting results is not enough. Providers are still adjusting to this new world of value-based payments. The industry has changed so quickly in the past few years that it is hard for providers to keep up. New programs and payment structures are placing a significant administrative burden on providers. Today’s physician practices are overwhelmed and many do not have sufficient resources to keep up with all of the changes.
Forward-thinking health plans aiming to outpace their competitors need to establish an approach to provide hands-on help to physician practices.
Understanding the Challenges Physician Practices Face
Most physician practices recognize they need to re-tool to better position themselves for success in the value-based care market, but they lack the time, focus, skills and resources to do it alone. Health plans have deep knowledge and understanding of the value-based care market, and they also understand HEDIS, CAHPS and other quality improvement metrics.
However, even with strong provider services staff in the field, health plans may not possess a detailed understanding of how physician practices work and the administrative burdens they face. Without understanding the internal workings of physician practices, the health plans cannot provide the level of support or assistance that physician practices need to succeed under value-based contracting arrangements.
In order to achieve meaningful results, health plans need to engage with expert resources that understand the inner workings of physician practices – both at the clinical and operational levels.
Helping Physician Practices Implement Change
Success in value-based care requires an “all hands on deck” approach to quality improvement and risk adjustment. Health plans possess a unique opportunity to improve their relationships with physician practices and meet their own internal revenue goals by providing hands-on support in the practice. Pushing down new technology and educational materials is not enough. Practices need expert coaches working side-by-side with physicians and their office staff to help them transform the way they work. This includes assessing, evaluating, and optimizing the practice’s existing technology, tools, and workflows. By supplying on-site coaches within the practice setting, health plans can also ensure that their tools and quality improvement programs are given top priority and become integrated into the practice’s operations.
Hands-on coaching drives meaningful improvement in patient care and health outcomes, while also attaining optimal financial performance for the health plan and the practice.
Achieving Results through Focused and Consistent Effort
Change is an iterative process. One of the biggest mistakes health plans make is asking providers to do too much at once. By breaking up the change effort into smaller and more manageable projects, providers will be able to achieve small victories over time. With each step, the provider office will gain confidence and build momentum toward more significant changes. With focused analytics, expert coaches will be able to target the improvement projects that will yield the most benefit for the health plan and the practice.
Health plans need to seek out the right partner to make all of this happen. Medical Advantage has refined our methodology over the past 20 years working in physician practices. Our Practice Catalyst approach is a proven method that leads to meaningful change and a positive return on investment for our customers. It is a hands-on approach to practice coaching that is scalable, replicable, and can be customized to meet the unique needs of each customer.
